J Tradit Med Clin Natur Copyright: © Szilard H, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Volume 59 Issue 10
Acupuncture: is one of the most accepted CAM therapies, most well: known branch of the Traditional Chinese Medicine, which flows intensive research a few decades in the US, Europe, even in China. Is backed by proving research results of Evidence Based Medicine for properly as well. Results: Acupuncture and TCM, are one of the most researched area of non—conventional, complementary therapies. We have already demonstrated convincingly established by the management of the majority of acupuncture point physiological responses.
The mediator neurohormonal transmitters are already known about now. The performance of in: service training is a university competence. Evidence Based Medicine has an efficient and effective use based on the quality of training in: service training, which is conducted in some Universities for more decades. Further development of this training, quality education can only be realistic to achieve the goals which effectively give rise to a dedicated TCM Confucius Institute Pecs University.
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What is the essence of mechanical peripheral stimulus, the nervous and neurohumoral mechanism mediating acupuncture e. Is there an acceptable and relevant professional literature proving the efficiency of clinical acupuncture? The application of this principle can be carried out by mechanical stimulus: needle puncture, massage, temperature stimulus, vacuum based suction, as well as by ultrasound, laser, etc. In China it has been known for centuries about different herbs on which meridian they are effective and whether they belong to the type of yin or yang.
So the knowledge of channels and points was also taken into consideration in Chinese phytotherapy. We can say, that we are talking about a diagnostic and therapeutic whole body complex system 3 based on a unitary theoretic foundation which is consistent in itself. A newer recognition diabetes topics research paper the study and application of the Yamamato4 scalp system.
Is it more efficient to treat an acupuncture point already known than to place the needle into a sham acupuncture point? By examining the efficiency of acupunctural pain-killing [ 1 ] 6 came to the conclusion that pains induced in acute, laboratory conditions both in humans and animals could only be efficiently alleviated by stimulating acupuncture points, while in the case of treating non-acupuncture points there was no really measurable pain-killing effect observed.
At the same time, in the cases of chronic pain this difference is not so obvious. A great number of cases are needed to achieve the statistical significance a minimum of experimental persons per examination ; furthermore this issue has diabetes topics research paper been closed up to now. Do acupuncture points have a specific anatomic structure?
According to the finding of a number of microscopic and electromicroscopic examinations there is no separate structure apart from our skin sense organ representative of special acupuncture points, but a bigger number of sensory nerve endings can be recognized at the indicated points, e.
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Physiological and biophysical description of acupuncture points In Europe it was the French Niboyet who first described that the areas of the skin surface with low electrical resistance can be identified with acupuncture points. Simultaneous factors influencing skin resistance must also be taken into consideration since a measurement can be hindered by several influential factors temperature, surface humidity, calibration of the measuring device.
During the measurement we apply a very weak measuring current. The surface of the skin shows mV potential difference in its areas, where it is the surface to be considered more negative compared to the deeper layers [ 5 - 7 ].
When measuring skin potential values acupuncture points are also measurable and bigger differences can be measured in these areas. This partially gives an explanation on the chemical and physical processes induced by the needle applied. During acupuncture it is not only the damage potential that induces current, but also the needle itself functions as a thermo element, since when applying the needle there is a temperature difference of more than 10°C.
According to our latest knowledge it is a virtual network system which refers to the succesive sequences of the recognized bioactive acupuncture points, so it is not a separately and touchable anatomic structure. The very first clear answer to the nervous mediation of low— frequency Electroacupuncture EA applied via inserted needles was given by Chiang [ 11 ], whose research is still going on.
This explains why an electric stimulation with diabetes topics research paper frequency and higher current stability is important. This is in accord with the following nervous mechanism in case of applying a low frequency and high intensity electro-acupuncture EA. The fibres responsible for the impulse transmission are myelinated type 2 and 3 afferents with a small diameter.
They are responsible for the numbness and the feeling of fullness induced by the spreading needle sensation but the pain is mediated by the bare type 4 fibres.
In case of an activation of skin nerves the A-delta fibres play a role. This diabetes méhek kezelése inhibits either cukormentes ételek encephalin or dynorphin mediation but not through ß-endorfin one, which means it blocks the transmission of the pain stimuli. Diabetes topics research paper topics research paper, the encephalins and the dynorphin may block the pain already at the level of the spinal cord.
Next the needle stimuli advance through the ascending tracts to the thalamus in the spinal cord. In the peri-aquaeductal grey matter PAG of the midbrain it activates the raphe nucleus in the caudal part of the medulla oblongata through encephalin mediation. It sends back descending impulses in the dorsolateral part of the spinal cord DLT through monoamine serotonin and norepinephrine mediation to the cells of the spinal cord.
Both monoamine mechanisms might take part in pain-killing. The originally activated ascending tract in spinal cord also activates the nucleus arcuatus in the hypothalamus-hypophysis complex, while other parts of the hypothalamus receive ß-endorphin from the hypothalamus itself. It effects through the blood current only to a small extent, it rather gets to the cell on a direct retrograde way without getting through the blood-brain barrier Figures 1 and 2.
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Anyhow, the destruction of hypophysis in experimental animals inhibits the creation of an acupunctural effect. The hypophysis also releases ACTH in an equimolar amount with ß-endorphin since their precursor is common.
Figure 1: Regulation of acupuncture in EU. Adrenocorticotropic Hormone ACTH stimulates the adrenal gland to release cortisol, which explains the anti-inflammatory effect of acupuncture in conditions such as asthma, arthritis, etc. At the same time this little amount of cortisol does not have harmful side effects neither does it cause a positive feed-back.
The recent excellent radiological diagnostic techniques PET, fMRI prove that acupuncture can activate further diabetes topics research paper of central nervous system parts such as nucleus accumbens, amygdala, habenula, thalamic nuclei, etc.
In a study of volunteer participants with artificially induced toothache were treated by manual stimulation of Large Intestine 4 LI4 on hand acupuncture point 14 to relieve pain.
One group received intravenous saline; the other group received intravenous naloxone. None of the participants knew which group they were in. This is a typical example of double blind clinical research. In the first group the pain was eliminated in 30 min and the effect persisted longer than one hour.
The pain did not subside in naloxone group in spite of dry needling. At the same time the participants of placebo group received placebo injection with the instruction that it was a strong pain-killer medicine.
These participants did not experience any alleviation of their pain at all. Shortly after the publication, that the a kezelés a árnyékolás során cukorbetegség of naloxone needed to block AA depended on applied frequency of electro-acupuncture.
It is less in case of 2 Hz than in case of 15 Hz and comparatively lot more naloxone was necessary to inhibit pain relief induced by Hz EA. Based on cross-tolerance studies it has become certain that there are different endogenous opiate mediations depending on the frequency of needle stimulation, and diabétesz kezelésére lavrov this takes place via different receptors.
Based on this knowledge the explanation of the antihypertensive effect of acupuncture compared with angiotensinconverting- enzyme inhibitor ACE inhibitors is thought provoking.
Diabetes topics research paper antihypertensive effect of opioids was already known. Using the opioids as medicine is proved to be difficult because their elimination in the body is too fast.
On the other hand if we inhibit the final synthesis of angiotensin II-ACE inhibitors are examples of this-it loses its antiopioid effect; hence we can lower blood pressure, however it eventually happens due to opioid peptides of the body.
Lowering blood pressure in the so called neurogenic stage of hypertension could be achieved more directly through opioids facilitated by acupuncture.
Augmentation theory: Acupuncture raises the level of triglycerides, certain hormons, prostaglandins, leukocytes, gamma globulins, opsonins, and antibodies immunstimulatory effect. Endorphin theory: Acupuncture stimulates the production of endorphins especially the enkephalins, and dynorphins analgesia. Neurotransmitter theory: Acupuncture can influence on the production and secretion of several neurotransmitters serotonine, noradrenaline depression and emotional diseases, the decreased level of serotonin may lead to weight loss.
Gate control theory: On the level of interneurons of the spine acupuncture stimulated somatosensoric Diabetes topics research paper fibres block the thinner viscerosensor C fibers transmitting the incomming pain information, by which they prevent its spreading into higher level center and prevent the perceiving of pain anaestesy, analgesy, Diffuse Noxious Inhibiting Control: postulated by le Bars, Local segmental effect: axon reflex, vasoactive neuropeptides: mostly calcitonin gene related peptid CGRPsubstance P SP : Lundeberg, Kashiba, Schaffer, Calsson,endorphin: antiinflammatory effect Stein, Yassouridis, Differencess between extitatons of A: delta fibres and A: beta fibres, conduction velocity, inhibition of heterosegmental nociceptive stimulus Sandkuhler, they are the part of supraspinal descendal inhibiting mechanism.
Pomeranz,diabetes topics research paper analgesia: through stress: induced reduction of pain sensitivity Fancelov,short time activation of endorphin system but in such an extent explanation of diabetes topics research paper long term effect is not enough. Endorphin system: endorphinerg system activating Han, Xie,PekingTageshire, Pomeranz,Han Terenius, the most accepted explanation until this time, decrease of endorphin system regulation, chronic pain syndroms disreglative changes especially lumboischalgc pain, haedache, fibromylagia.
Endocrine effects: Hypothalamus activation Hsieh et al.
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Clinical effect of acupuncture can be assessed only based on human individuals, thoroughly prepared by observation. Later we follow basic rules of evidence—based medicine and then verified and confirmed clinical impact studies. Regular overview summarizing on the evidence based medicine Overall requirement for effectiveness confirmation is a sufficient amount of performed and well: prepared, random and controlled experiments.
Today, there is a specific statistical method, where individual examinations are an examined entity. Balanced usage of all the until now gained knowledge about medicine based on facts evidence based knowledge is conscientious and open to patient and based on current proven facts decides on the best possible treatment for patients [ 1112 ].
It is expected from the medical doctor that he has possibly the best clinical experiences in given specialization and is educated by the best research results.
In system included publications, whatever the results were, have to match certain specification requirements. New outcomes of working hypothesis formulation are important for future research.
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In order to eliminate possible bias we use so: called sensitivity analysis. There we compare and examine better and worse results of individual experiments and those are then compared only with results and outcomes of the better experiments. We are also calling it biased when the outcomes—whether intentionally or not—are evaluating the one and the same experiment numerous times for example: when the experiment was published more times but under different names. CAMbrella—the Pan: European Union research project 19 included one worksheet, which was discussing this topic in the recent past, when they analyzed approximately The proven clinical efficacy of the acupuncture The acupuncture treatment means a diagnosis of the patient as an individual and a planned treatment according to the given clinical pattern [ 13 ].
This also means that according to the unique, extremely detailed Chinese pulse and tongue examination there are no two patients totally alike.
In this regard, it is a great task to contract the results of certain experiments but the randomization itself is also dif ficult. While certain problems are always treated on the same point for instance nausea and vomiting are treated on Pericardium: 6 acupoint 20in case of a chronic pain syndrome different treatment protocols must be followed depending on the accompanying symptoms. In order to apply the right acupuncture treatment the criteria are not only the selection of the right puncture points but also the consideration of further factors: Linde et al.
The adequacy of acupuncture can also be estimated by the minimum number of acceptable treatments.
According to the criteria of Molsberger and Bowing [ 15 ] it means at least 10 sessions of treatments in diabetes topics research paper each single treatment session is a minimum of 15 min long and the record of the used acupuncture points. Patel et al. Although this approach in itself does not give an answer whether the applied acupuncture has been effective enough against the actual disease, it can be observed that experimental group members preferred treatments tailored individually to selection of points according to the standard formula.
But how to integrate individual treatments into controlled experimental methods? The certain sub: group members will be treated on the points according to the formula.
A közep-magyarorszagi regioban szignifikansan ala-csonyabb volt az olyan cukorbeteg resztvevok aranya 1. Nyugat- Közep- Kelet- 1. A cukorbetegseg es az RD elofordulasi aranya különösen fontos az 50 eves es idosebb koru lakossag köreben, hiszen a vaksag es a sulyos latasromlas prevalenciaja ezen eletkor felett a legmagasabb .
Following the latter approach it is known that there is no connection between the number of treated points and the successfulness of a treatment, however scientists found a statistically significant relation regarding the number of treatments and the successfulness of the cure. Getting less than 6 treatments was never efficient enough, but those patients who undergone 10 treatments recovered more successfully. According to the efficacy examination of acupuncture treatments for lumbal pain acupuncture is a suitable method but only recommended as a complementary treatment.
It was found after the statistical evaluation of 7 studies on fibromyalgia that acupuncture is much more effective than [ 8 ] sham acupuncture, but there was not a long: term follow up carried out in the examined studies. Ernst et al. In a systematic review of 22 experiments Melchart et al. They came to the conclusion that, although there is not sufficient data diabetes topics research paper prove that acupuncture is better than treating with medicine [ 16 ] patients with recurrent headache can be encouraged to try acupuncture